P1594: LACTATE DEHYDROGENASE / ALBUMIN TO-UREA RATIO, A NEW PROGNOSTIC MARKER FOR THE PREDICTION OF COVID-19 INFECTION ASSOCIATED CLINICAL COMPLICATIONS.
Authors: H. Shokr, M. Marwah, H. Siddiqi, F. Wandroo, S. Marwah
Journal: HemaSphere (2022)

Background:SARS-COV-19 is an RNA virus that spreads rapidly via droplets, aerosols, and contaminated surfaces. Infection by the new corona virus strain (COVID-19) and its related syndrome has been associated with more than 6 million deaths worldwide. Most infected patients suffer from mild to moderate illness, however some patients progress rapidly to acute respiratory distress syndrome, respiratory failure, sever sepsis, multiorgan failure and death. Early identification of those at risk of progression to critical illness can assist appropriate provision of early intensive interventions and priority access to the intensive care units. Currently high neutrophil to lymphocyte ratio has been suggested as a short-term disease prognostic indicator in critically ill patients, however, to date there are no available indictors to predict critical illness. Aims:To investigate differences in biomedical markers and routine haematology indices to provide a potential novel ratio as predictor for COVID-19 induced critical illness and death. Methods: This retrospective study involved 1139 COVID-19 infection survivors as derivation cohort and 349 COVID-19 deaths as a validation cohort. Peripheral blood samples were collected from all the study population and routine laboratory indices, inflammatory markers and organ function tests were analysed on admission. Results: Compared to COVID-19 infection survivors, patients who didn’t survive showed lower haemoglobin concentrations (p=<0.001), platelets count (p=0.0001) and higher mean corpuscular volume, neutrophil count, neutrophil/lymphocytes ratio (NLR), and lactate dehydrogenase/albumin to urea ratio (LAU) (p=0.001, p=0.0013, p=<0.001, p=0.0126 respectively). They also exhibited higher infection related clinical complications expressed as higher international normalized ratio (INR), D-dimer, urea, total bilirubin levels, alkaline phosphatase (ALK), creatinine, c-reactive protein (CRP), and serum ferritin levels (p<0.05 in all). Lactate dehydrogenase/Albumin ratio was identified as an independent risk factor for end organ damage and clinical complications in COVID-19 positive patients. The LAU ratio was significantly and positively correlated with infection-related clinical complications prognostic parameters including INR (r=0.171), D-dimer (r=0.176), serum urea (r=0.424), total bilirubin (r=0.107), ALK (r=0.115), creatinine (r=0.365), CRP (r=0.268), ferritin (r=0.385) and negatively correlated with serum albumin levels (r=-0.114) (p=<0.05 in all). Additionally, The LAU ratio had an area under receiver operating characteristic (ROC) of 0.67 (95% confidence interval 0.56 to 0.79) compared to 0.60 (95% confidence interval 0.54 to 0.68) using NLR. Summary/Conclusion: We found that LAU ratio is a new predictive factor for COVID-19 induced clinical complications and death. Patients having a LAU ratio above 54.7 are predicted to die from the infection thus close monitoring and early intensive intervention should be offered to these patients to control infection-related complications.